Nursing homes and long-term-care pharmacies are sometimes paying for Part D drugs that are not covered by residents plans, according to a report from HHS inspector generals office.
The office interviewed a sample of nursing home administrators, medical directors and directors of operations for long-term-care pharmacies for their research from September 2006 to March 2007. Most of the respondents said nursing home residents eligible for both Medicare and Medicaid were receiving all necessary Part D drugs.
However, some claim theyre footing the bill for the drugs themselves: 45% of administrators and 77% of the pharmacy directors reported that they paid for at least one Part D drug for dual-eligible nursing home residents. Administrators and pharmacy directors said the drugs they most commonly paid for were either not on formularies of the residents insurance plans or required prior authorization.
The CMS concurred with the offices recommendations to work with plans to ensure that formularies meet the needs of dual-eligible nursing home residents and to improve the prior authorization process. The agency should also continue its efforts to ensure that copayments for dual-eligible nursing home residents are fully subsidized, as appropriate, the inspector generals office suggested. -- by Jennifer Lubell